Fillable Personal Information Student Employment Application (Humboldt State University)

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Personal Information Student Employment Application (Humboldt State University)

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The Personal Information Student Employment Application (Humboldt State University) form is 2 pages long and contains:

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Country of origin: US
File type: PDF

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Student Employment Application
POSITION APP
LIED FOR ____________________________________
1 Harpst Street, Arcata, California 95521 • 707.826.4878 DATE _______________________________
Personal Information
LAST NAME __________________________________ FIRST NAME ___________________________________ MIDDLE INITIAL ____________
MAILING ADDRESS ___________________________________________ APT # ______ CITY ________
____________________ STATE _______ ZIP ___________
PHONE NUMBER ( ________) ________ - _________ E-MAIL __
______________________________________________________________________________
EMERGENCY CONTACT: NAME PHONE ( _____) ______ - _______ ALT. PHONE ( _____) ______ - _______
• Have you been awarded Work Study Funds? Yes No
• Are you eligible for employment in the United States? Yes No
• Have you ever been a member of CalPERS, or have been employed by another California State Agency, Campus or
Public Agency? Yes No
IF YES, name of employer: Separation Date:
• Have you worked at, or are currently working for, any of the departments listed below? Yes No
If yes, please mark which one(s):
Center Activities Humboldt Bay Aquatic Center Student Recreation Center CenterArts
UC Information Counter The Depot The “J” Hilltop Marketplace Giant’s Cupboard
College Creek Marketplace Window’s Cafe Library Cafe
Other HSU campus departments: ___________
__________________________________
Education
SCHOOL NAME LOCATION
UNITS OR GRADE
LEVEL COMPLETED
DEGREE /
CERTIFICATE
RECEIVED
MAJOR / AREA
STUDIED
Skills, Licenses & Training
Please list any specialized skills you possess relating to the area you are applying. Examples include cash register use, food
preparation, customer service, computers and software programs, etc.
Revised 01-2018
continued on next page
Employment History
List your last two (2) employers, assignments or volunteer activities, starting with the most recent, including military
experience. If you would like to include additional employment history, please attach it on a separate page.
FROM
TO
EMPLOYER
TELEPHONE
JOB TITLE
ADDRESS
CITY
STATE ZIP
IMMEDIATE SUPERVISOR & TITLE
SUMMARIZE THE NATURE OF WORK PERFORMED AND JOB RESPONSIBILITIES
FROM
TO
EMPLOYER
TELEPHONE
JOB TITLE
ADDRESS
CITY
STATE ZIP
IMMEDIATE SUPERVISOR & TITLE
SUMMARIZE THE NATURE OF WORK PERFORMED AND JOB RESPONSIBILITIES
REASON FOR LEAVING
• May we contact your present employer? Yes No
References (work-related preferred)
NAME TELEPHONE YEARS KNOWN
•
It is understood and agreed upon that any misrepresentation by me on this application will be sufficient cause for cancellation of this
application and/or separation from the employer’s service if I have been employed.
• I give the employer the right to investigate all references and to secure additional information about me, if job related. I hereby release
from liability the employer and its representatives for seeking such information and all other persons, corporations or organizations for
furnishing such information.
• The employer does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing
any applicant’s consideration for employment on a basis prohibited by local, state, or federal law. I understand it is this company’s
policy not to refuse to hire a qualified individual with a disability because of this person’s need for an accommodation that would be
required by the ADA.
SIGNATURE OF APPLICANT:
________________________________________
DATE: _____________________
Revised 01-2018
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Personal Information Student Employment Application (Humboldt State University)

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Completed 25 March 2021

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